Development and Validation of a Low-Cost and Simple Simulator for Microlaryngeal Surgery

Objectives@#. The simulation of microlaryngeal skills is rarely seen in surgical training, but it is particularly important in phonomicrosurgery. This study described and validated the laryngeal surgical simulator through surgical training. @*Methods@#. A simple and low-cost simulator was developed for the fixation of the suspension laryngoscope and porcine larynges. Twenty participants with work skills and experience did preparation before training, and performed suture and carbon dioxide (CO2) laser cordectomy for simulator evaluation. The results were proposed by the aspects of time taken for each procedure, the global rating scale, a procedure-specific assessment, and a post-simulation questionnaire. @*Results@#. All participants completed the preparation within 9 minutes and reached the conclusion that the microlaryngeal surgical simulator was helpful in improving their surgical skills. The performance of experts was superior to that of novices in both suture and CO2 laser cordectomy. @*Conclusion@#. This simulator could be easily assembled and was successfully validated by microlaryngeal surgical training both subjectively and objectively. It may be helpful to clinicians in microlaryngeal skills.

Subtype analysis and clinical significance of HPV infection in laryngeal squamous cell carcinoma and precancerous lesions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the correlation of laryngeal squamous cell carcinoma (LSCC) and precancerous lesion with HPV infection subtypes and possible clinical relationship.@*METHOD@#Eighty-three cases in paraffin embedded tissues were detected with thirty seven HPV subtypes by flow-through hybridization and gene chip (HybriMax), including 31 cases of laryngeal squamous cell carcinoma, 52 cases of precancerous lesions (29 cases of vocal cord leukoplakia and 23 cases of laryngeal papilloma), and 36 cases of vocal cord polyp as normal vocal mucosa were used as control.@*RESULT@#The total positive rate of HPV was 19.4% in the group of laryngeal squamous cell carcinoma (6/31), 0 in vocal cord leukoplakia, 65.2% in laryngeal papilloma (15/23), and the control group were all negative, HPV virus subtype of HPV-positive laryngeal squamous cell carcinoma were all high-risk HPV16; and there were 6 HPV virus subtypes in laryngeal papilloma (8: HPV6,4: HPV52, 1: HPV11, 1: HPV18, 2: HPV45, 3: HPV16), individual mixing two or more subtypes infection. HPV infection of laryngeal squamous cell carcinoma and precancerous lesions has no statistically significant difference according to gender, high low-risk subtypes.@*CONCLUSION@#HPV infection related to laryngeal squamous cell carcinoma and precancerous lesions, but no significant correlation with the subtype distribution of high and low risk; HPV detection is making positive sense to clinical diagnosis of laryngeal carcinoma and precancerous lesions as well as the development of specific HPV subtype vaccine.

VocaI PoIyps and Precancerous Lesions Treated with CO2 Laser and ConventionaI LaryngeaI Microsurgery / 听力学及言语疾病杂志

Objective To compare the efficacy of CO2 laser and conventional laryngeal microsurgery in the treatment of benign lesions of vocal cord (polyp of vocal cord) and precancerous lesions (leukoplakia of vocal cord) of patients. Methods A total of 60 patients with vocal cord polyps were selected, and randomly divided into two groups, each with 30 patients. Thirty patients with vocal cord leukoplakia were selected and randomly divided into two groups, each with 15 patients. One group was performed by cold instruments for lesion resection (conventional group), the other by CO2 laser for removal of diseased tissue or mucosal ablative surgery (laser group). Two groups of patients were examined by laryngostroboscope, electronic laryngoscopy, GRABS, VHI subjective ratings and objective voice analysis before operation and one week, one month and three months after operation. ResuIts The outcomes of those with vocal cord polyps in early recovery (1 week) laser group were slightly worse than the conventional group. In later recovery (1~3 months), with electronic laryngoscopy inspection, laryngostroboscope mucosal wave observation, the analysis of subjective and objective data from the two groups showed no significantly differences. For patients with vocal cord leukoplakia in early recovery (1 week), laser group slightly worse than the conventional group, in later recovery (1~3 months), there were no obvious difference between the two groups in electronic laryngoscopy inspection, laryngostroboscope mucosal wave observation, the analysis of subjective and ob_jective data. Follow -up operations, the recurrence rates in laser group was significantly lower than conventional group. ConcIusion The treatment by CO2 laser can significantly improve their pronunciation quality for vocal cord polyps and vocal cord leukoplakia patients, it has a good therapeutic effect, especially the long-term effective of vo_cal cord leukoplakia is better than conventional operation.

Expression of C-erbB-2 and EGFR expression and its relationship with cell proliferation in nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expression of epidermal growth factor receptor (EGFR), C-erbB-2 and its relationship with cell proliferation in nasopharyngeal carcinoma.@*METHOD@#Expression of C-erbB-2, EGFR and proliferating cell nuclear antigen (PCNA) were detected with immunohistochemical staining in 32 nasopharyngeal carcinoma samples and 12 chronic inflammatory nasopharyngeal tissue samples.@*RESULT@#The positive rate of EGFR,C-erbB-2, and PCNA expression in nasopharyngeal carcinoma was 65.6%, 37.5%, and (42.5 +/- 22.6)%, respectively, which was significantly higher than that in chronic inflammatory nasopharyngeal tissue (P < 0.05). There were positive correlations between the positive rate of EGFR, C-erbB-2, and PCNA expression and histopathological stage. The co-expression of C-erbB2 and EGFR was found in 62.5% (20/32) nasopharyngeal carcinoma samples. There was a positive correlation between C-erbB-2 and EGFR expression (r = 0.38, P < 0.05). The highest percentage of PCNA expression was found in carcinoma samples with co-expression of C-erbB and EGFR.@*CONCLUSION@#C-erbB-2, EGFR might have synergetic effect in the development and progress of nasopharyngeal carcinoma. The co-expression of C-erbB-2 and EGFR closely correlates with cell proliferation status.

Preventing laryngeal anterior commissure adhesion after operation: a study in canines / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the better operational methods by the laser surgery to treat diseases involving the laryngeal anterior commissure. It can excise the diseases as well as avoid anterior commissure adhesion, laryngostenosis and dyspnea after operations.@*METHOD@#Twelve dogs were divided into 4 groups at random. There were three dogs in one group. A: excising experimental dog's anterior commissure by twice operations, the interval time was two weeks; B: excising experimental dog's anterior commissure in one time, at the same time suturing the silica gel sheet on the anterior commissure; C: excising experimental dog's anterior commissure in one time and then applying MMC on the wound of the anterior commissure; D: excising experimental dog's anterior commissure in one time, without any treatment.@*RESULT@#All of the dog's surgery were completed successfully by laser. Four weeks later, we observed the raw surfaces. A: the neonatal membrane covered the wound, inflammatory reaction slight, we could not see obvious adhesion in the anterior commissure. B: the membrane covered the wound, appearing the dark chronic inflammation, we could see the adhesion in the anterior commissure slight. C: the membrane covered the wound, edematization, we could see the moderate adhesion in the anterior commissure. D: edematization, we could see the adhesion in the anterior commissure obviously. Four groups were all appeared hoarsenesses, the most slightly in group A, secondly in B and C, the worst in D. The analysis of vocal cord length of 4 groups, we used matched-pairs t-test, A, B, C groups' P>0.05, the vocal cord length didn't become shorter than before obviously. Group D's P0.05, the glottis area didn't shrink than before obviously. C and D groups' P0.05), we could not think that the changes of four groups have disparity.@*CONCLUSION@#Excising the experimental dog's anterior commissure by laser, compared the 4 different operation methods, group A is the best method. B and C are inferior. The results are valuable in clinic when we perform operations by laser to treat the disease involving the anterior commissure.

Studying on patient's nasal cycle of OSAHS with acoustic rhinometry / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the effect of OSAHS on adult nasal-cycle.@*METHOD@#The nasal cycle of 20 healthy adults, 18 patients of snoring and 22 patients of OSAHS were examined with acoustic rhinometry, which was performed every 30 minutes in 7 hours.@*RESULT@#The ratio of nasal cycle in healthy adults was (19/20, 95.0%), in snoring patients was (15/18, 83.0%), in patients of OSAHS was (15/22, 68.2%). The mean alteration amplitude of nasal cycle in healthy adults was significantly larger than that in patients with OSAHS (P < 0.05). The distribution of the healthy adults and patients with OSAHS between the typical cycle categories was significantly different (P < 0.05).@*CONCLUSION@#The characteristics of nasal-cycle in of OSAHS patients were different with healthy adults, which maybe owing to change of physical function of basal cavity.

Studying on patient's nasal cycle of OSAHS with acoustic rhinometry / 临床耳鼻咽喉头颈外科杂志

Objective:To study the effect of OSAHS on adult nasal-cycle.Method:The nasal cycle of 20 healthy adults,18 patients of snoring and 22 patients of OSAHS were examined with acoustic rhinometry,which was performed every 30 minutes in 7 hours.Result:The ratio of nasal cycle in healthy adults was(19/20,95.0%), in snoring patients was(15/18,83.0%),in patients of OSAHS was(15/22,68.2%). The mean alteration amplitude of nasal cycle in healthy adults was significantly larger than that in patients with OSAHS (P<0.05).The distribution of the healthy adults and patients with OSAHS between the typical cycle categories was significantly different(P<0.05).Conclusion:The characteristics of nasal-cycle in of OSAHS patients were different with healthy adults,which maybe owing to change of physical function of nasal cavity.

Expression of CD23 and CD19 on peripheral blood lymphocytes and its association with serum total IgE in patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the expression of CD23, CD19 on peripheral blood lymphocytes as well as its association with serum total IgE levels and nasal allergic symptoms in patients with allergic rhinitis (AR).@*METHOD@#Symptom scores were evaluated in 46 AR patients, expression of CD23, CD19 on peripheral blood lymphocytes were measured by flow cytometry, and serum total IgE levels were determined by immune chemiluminescence. Thirty two healthy individuals were enrolled as controls.@*RESULT@#The percentage of CD23+, CD19+ and CD23+/ CD19+,on peripheral blood lymphocytes in AR patients were 11.6 +/- 1. , 22.8 +/- 3.3,10.2 +/- 1.7, respectively. Higher frequencies of CD23+, CD19+, and CD23+/CD19+ were found in AR patients compared with controls (P < 0.05). There were positive correlations between expression rates of CD23+, CD19+, CD23+/CD19+ and levels of serum total IgE, nasal allergic symptom scores, respectively. CD23+/CD19+ demonstrated greater correlations with serum total IgE and nasal allergic symptom (r = 0.65 and 0.49, P < 0.05) than CD23+ and CD19+ did. Correlation between CD23+/CD19+ and nasal allergic symptom scores was greater than the corresponding correlations of serum total IgE (r = 0.33, P < 0.05).@*CONCLUSION@#CD23 and CD19 are important factors that associated with serum total IgE in the pathogenesis of AR, Analysis on the expression of CD23+/CD19+ on peripheral blood lymphocytes is helpful for evaluating the severity of AR.

Observation of cranial nerves in the cerebellopontine angle region by retrosigmoid approach / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the anatomical structures of cranial nerves in the cerebellopontine angle region to offer anatomical data for clinical operation.@*METHOD@#A total of 52 adult cadaveric heads fixed in 10% formalin were used for this study. After cutting cerebellum and meningeal between transverse and sigmoid sinus, simulate operating method of retrosigmoid approach to observe the cranial nerves.@*RESULT@#External diameter and length of left V, VII, VIII, IX cranial nerves are (2.54 +/- 0.84) mm and (6.79 +/- 2.51) mm, (1.18 +/- 0.31) mm and (9.89 +/- 2.66) mm, (2.17 +/- 0.52) mm and (9.92 +/- 2.61) mm, (0.77 +/- 0.24) mm and (10.34 +/- 3.12) mm respectively. External diameter and length of right V , VII, VIII, IX cranial nerves are (2.52 +/- 0.86) mm and (6.91 +/- 2.66) mm, (1.14 +/- 0.31) mm and (10 +/- 2.96) mm, (2.13 +/- 0.63) m and (10.09 +/- 2.93) mm, (0.790.29) mm and (10.17 +/- 3.06) mm. intermedius nerve locate between facial nerve and acoustic nerve, external diameter of intermedius nerve is (0.47 +/- 0.91) mm (left) and (0.37 +/- 0.07) mm (right). Length of vagal nerve is (10.44 +/- 2.57) mm (left), (9.91 +/- 2.91) mm (right), rootlets of f vagal nerve is 6.37 +/- 2.26 (left) and 6.33 +/- 2.38 (right). external diameter of accessory nerve is (0.76 +/- 0.16) mm (left) and (0.81 +/- 0.19) mm (right).@*CONCLUSION@#This study provide anatomical data for retrosigmoid approach in the cerebellopontine angle region.

Expression of CD23 and CD19 on peripheral blood lymphocytes and its association with sreum total IgE in patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the expression of CD23,CD19 on peripheral blood lymphocytes as well as its association with serum total IgE levels and nasal allergic symptoms in patients with allergic rhinitis(AR). Method:Symptom scores were evaluated in 46 AR patients,expression of CD23,CD19 on peripheral blood lymphocytes were measured by flow cytometry,and serum total IgE levels were determined by immune chemiluminescence. Thirty two healthy individuals were enrolled as controls.Result:The percentage of CD23~+,CD19~+ and CD23~+/CD19~+,on peripheral blood lymphocytes in AR patients were 11.6±1.9,22.8±3.3,10.2±1.7,respectively.Higher frequencies of CD23~+,CD19~+,and CD23~+/CD19~+ were found in AR patients compared with controls (P＜0.05).There were positive correlations between expression rates of CD23~+,CD19~+,CD23~+/CD19~+ and levels of serum total IgE,nasal allergi symptom scores,respectively.CD23~+ /CD19~+ demonstrated greater correlations with serum total IgE and nasal allergic symptom(r=0.65 and 0.49,P＜0.05)than CD23~+ and CD19~+ did.Correlation between CD23~+/CD19~+ and nasal allergic symptom scores was greater than the corresponding correlations of serum total IgE(r=0.33,P＜0.05).Conclusion:CD23 and CD19 are important factors that associated with serum total IgE in the pathogenesis of AR,Analysis on the expression of CD23~+/CD19~+ on peripheral blood lymphocytes is helpful for evaluating the severity of AR.

The recovery study of excising the different range of dog's anterior commissure by semiconductor laser / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the effective method to treat the glottic carcinoma invading the anterior commissure, we observed the difference of three kinds of operation to the anterior commissure of dogs by semiconductor laser.@*METHOD@#Twelve dogs were divided into 3 groups at random, A: to cauterize to the thyroid cartilage's inner membrane of the anterior commissure, the right ventricular bands and vocal cord, the anterior and 1/3 of the left vocal cord; B: to cauterize part of the thyroid cartilage of the anterior commissure besides A; C: to open a window about 5 mm x 5 mm on the thyroid cartilage of the anterior commissure besides B. To take photos to observe the dogs' laryngeal wound with digital camera or electrolaryngoscope immediately, 1 week and 4 weeks, then to record the hoarseness, body weight and complications etc.@*RESULT@#All the dogs' laser surgery were completed successfully. To observe the gross specimen, it was identical between the extent of excising and the design preoperation. One week later, the neonatal membrane covered the wound incomplete. Edematization, inflammatory reaction, pseudomembrane and the hoarseness were not heavy too. No obvious complication in group A. The neonatal membrane covered the wound incomplete. Edema, inflammatory reaction, pseudomembrane and granulation can be seen in group B. Exudation was heavy in local, erosion and infected, the hoarseness was severe. No other obvious complications in C. Different extent of adhesion could be seen at the anterior commissure in group A, B and C after 4 weeks, the laryngeal web formed, and the length of vocal cord was shorter than before. The color and luster of anterior commissure membrane was normal basically, the inflammatory reaction was not heavy in A and B groups. The anterior commissural membrane appeared the dark red chronic inflammatory reaction; the window was closed by neonatal membrane completely and had no infection in group C. To observe the gross specimen: the wound of anterior commissure was covered by prosthetic epithelia completely in three groups. The window was closed by complete membrane at the anterior commissure. The No. 1- 3 dog's conditions of hoarseness in three groups after 4 weeks: slight in A group, little severe in B and C group. The change of weight was not obvious at the pre or postoperative in group A and B. No obvious complication happened in each group postoperation.@*CONCLUSION@#The three operative methods have satisfied effects,the recovery of wound can cure well finally and no severe complications happened. It is valuable in clinic.

Relationship of local recurrence with expression of protein P53 and PCNA in laryngeal carcinoma and its surgical margins / 第二军医大学学报

Objective:To explore the relationship of the local recurrence with the expression of protein P53 and PCNA in the primary lesions and the surgical margins of laryngeal carcinoma.Methods:The primary lesions and the surgical margins of la- ryngeal carcinoma of 36 patients were made into serial sections.Immunochemical method(H-E staining)was used to detect the expression of P53 and PCNA protein.Results.The positive rates of protein P53 and PCNA were 55.6%(20/36)and 88.9% (32/36)in the primary lesions,and 25%(9/36)and 30.6 %(11/36)in the surgical margins,respectively.The recurrent rates of the primary lesions positive for P53 and PCNA were 35%(7/20)and 25%(8/32),respectively,which were higher than those negative for them(12.5% [2/16]and 25% [1/4]).The recurrent rates of surgical margins positive for p53 and PCNA were 44.4%(4/9)and 72.7%(8/11),respectively,which were higher than those negative for them(18.5% [5/27]and 4%[1/ 25]).The expression of P53 and PCNA proteins in the primary lesions and surgical margins was abnormal;the recurrent rate of the laryngeal carcinoma was 100%(4/4)after surgery.Conclusion:P53 and PCNA protein can be used as biomarkers for local recurrence of laryngeal carcinoma after operation.Detection of P53 and PCNA in both the primary lesions and the surgical mar- gins may be of greater significance in forecasting local recurrence.